What Are the Barriers to Mobilizing Intensive Care Patients?

Purpose

Recently there has been increased interest in early mobilization of critically ill patients. Proposed benefits include improvements in respiratory function, muscle wasting, intensive care unit (ICU), and hospital length of stay. We studied the frequency of early mobilization in our intensive care unit in order to identify barriers to early mobilization.

Methods

A 4-week prospective audit of 106 patients admitted to a mixed medical-surgical tertiary ICU (mean age 60 ± 20 years, mean APACHE II score 14.7 ± 7.8) was performed. Outcome measures included number of patient days mobilized, type of mobilization, adverse events, and reasons for inability to mobilize.

Results

Patients were mobilized on 176 (54%) of 327 patient days. Adverse events occurred in 2 of 176 mobilization episodes (1.1%). In 71 (47%) of the 151 patient days where mobilization did not occur, potentially avoidable factors were identified, including vascular access devices sited in the femoral region, timing of procedures and agitation or reduced level of consciousness.

Conclusions

Critically ill patients can be safely mobilized for much of their ICU stay. Interventions that may allow more patients to mobilize include: changing the site of vascular catheters, careful scheduling of procedures, and improved sedation management.Key Words: intensive care units, mobility, physical therapy     

In search of good citizenship education: A normative analysis of the International Civic and Citizenship Education Study (ICCS)

In the last two decades, calls to place citizenship education (CE) at the top of national and European educational policy and research agendas have been gaining in prominence. Large‐scale comparative studies, such as the International Civic and Citizenship Education Study (ICCS), are often considered the main evidence base for setting these agendas and improving CE policies and practices. This article therefore considers the ICCS study as an inherent part of the process of translating general, educational aims into curricular policies and practices of CE. However, while critical voices about comparative educational studies have become paramount, a detailed analysis of their contents, of what and how they measure and what they promote as the aims of education is often lacking. This article aims to fill this gap by analysing the main research documents, design and items of the 2009 ICCS study. To find out what ICCS promotes as the goals of citizenship education, we examined its normative assumptions in terms of qualification, socialisation and/or subjectification. Our analysis shows that the qualification and socialisation functions are dominantly validated in all aspects of the study, whilst there is only marginal attention to subjectification. This implies that ICCS misses an important potential to document and/or promote pupils becoming autonomous and critical democratic citizens, whilst this is often considered a central aim of citizenship education by policymakers, practitioners and teachers.     

Learning Science Concepts by Teaching Peers in a Cooperative Environment: A Longitudinal Study of Preservice Teachers

Misconceptions of science principles are frequent among university students. This is particularly problematic in teacher education, as these misconceptions can be passed on by teachers to pupils at school. In this study, 40 preservice teachers studied 8 common misconceptions by 3 different approaches: learning by teaching (LbT) and learning from peers (LfP; both organized in cooperative groups and using self-developed activities) and conventional lecturing. Participants’ understanding was evaluated prior to, 1 month after, and 2 years after instruction, together with their views on the effectiveness of these methods for achieving learning. The 3 approaches improved scores on all posttests, but LbT achieved the best results. This coincided with perceptions of the participants who gave diverse reasons for the success of LbT. For lecturing, the longitudinal perspective showed that gains in student learning at 1 month had partially declined by 2 years, even though there was still a medium effect size compared to the pretest. However, for LbT and LfP gains remained statistically stable throughout. A combination of these methods might not only contribute efficiently to conceptual change for a good number of misconceptions but also connect teacher education to an almost real school classroom, giving opportunities to translate student learning into teaching practice.     

The Role of Cognitive Appraisal and Friendship Provisions in Adolescents' Affect and Motivation toward Activity in Physical Education

Abstract

This study investigated the mediational role of affect in the influence of perceived success, causal attributions, and friendship provisions on choice and future expectancies for success and enjoyment, using a multi-sample structural equation modeling approach. Subjects were 422 seventh- and eighth-grade students participating in physical education classes. Higher levels of perceived success, personally controllable attributions, companionship, and esteem support were found to positively influence levels of affect experienced, which in turn enhanced future expectancies for success and enjoyment in physical education and choices to participate in physical activity outside of school. Furthermore, participation experience outside of school influenced, adolescents' perceptions within the physical education setting and their consequent affect and motivation.     

Effects of increasing and decreasing physiological arousal on anticipation timing performance during competition and practice

The aim of this study was to investigate if the effects of changes in physiological arousal on timing performance can be accurately predicted by the catastrophe model. Eighteen young adults (8 males, 10 females) volunteered to participate in the study following ethical approval. After familiarisation, coincidence anticipation was measured using the Bassin Anticipation Timer under four incremental exercise conditions: Increasing exercise intensity and low cognitive anxiety, increasing exercise intensity and high cognitive anxiety, decreasing exercise intensity and low cognitive anxiety and decreasing exercise intensity and high cognitive anxiety. Incremental exercise was performed on a treadmill at intensities of 30%, 50%, 70% and 90% heart rate reserve (HRR) respectively. Ratings of cognitive anxiety were taken at each intensity using the Mental Readiness Form 3 (MRF3) followed by performance of coincidence anticipation trials at speeds of 3 and 8 mph. Results indicated significant condition × intensity interactions for absolute error (AE; p = .0001) and MRF cognitive anxiety intensity scores (p = .05). Post hoc analysis indicated that there were no statistically significant differences in AE across exercise intensities in low–cognitive anxiety conditions. In high–cognitive anxiety conditions, timing performance AE was significantly poorer and cognitive anxiety higher at 90% HRR, compared to the other exercise intensities. There was no difference in timing responses at 90% HRR during competitive trials, irrespective of whether exercise intensity was increasing or decreasing. This study suggests that anticipation timing performance is negatively affected when physiological arousal and cognitive anxiety are high.